Background: Dabigatran is a direct thrombin inhibitor belonging to direct oral anticoagulants (DOACs), which are rapidly replacing warfarin as oral anticoagulants in nonvalvular atrial fibrillation (NVAF) or venous thromboembolism. One major advantage with dabigatran compared to warfarin is that no routine testing is required. Nevertheless, the degree of anticoagulation should be determined in cases of severe bleeding or urgent surgery. Routine coagulation tests have proven to be inadequate for sensitive determination of the anticoagulant effect of dabigatran. Rotation thromboelastometry (ROTEM) is a new viscoelastometric point-of-care-test for the complex evaluation of changes in hemostasis introduced to clinical practice. This assay allows quick complex testing of hemostasis in one blood sample.
Aims: The aim of this study was to study the anticoagulant effects of dabigatran in patients with atrial fibrillation (AF) as assessed by the whole blood assays ROTEM, and how data from these methods correlate to plasma dabigatran concentrations measured by Hemoclot.
Methods: ROTEM was performed with ROTEM Gamma (Pentapharm GmbH, Munich, Germany). Plasma dabigatran concentrations were determined by hemoclot thrombin inhibitor assay (Hyphen BioMed, France) at trough and post-dose in patients on dabigatran 150 mg BID.
Results: Median plasma dabigatran concentrations at trough were 74 ng/mL (11.2–250) and post-dose (2 h after ingestion) 120 ng/mL (31–282). The ROTEM clotting time (CT) and maximum clot firmnes (MCF) correlated strongly with dabigatran concentrations when activated with the reagents Ex-tem (p < 0.0001) and In-tem (p < 0.0001).
Conclusion(s): In summary, in our study, we have found that the ROTEM variable CT and MCF, when activated with triggers Ex-tem and In-tem, has a strong and highly significant correlation with the plasma dabigatran concentration in a real-life population of AF-patients and could thereby be an alternative to estimate dabigatran concentration in emergency situations. However, additional studies are needed to further validate these findings. The study was supported by grants VEGA 1/0250/22.
To cite this abstract in AMA style:Sokol J, Nehaj F, Mokan M, Zolkova J, Linekova L, Antosikova A, Stasko J. Assessing Coagulation by Rotational Thromboelastometry (ROTEM) in Dabigatran-Anticoagulated Blood [abstract]. https://abstracts.isth.org/abstract/assessing-coagulation-by-rotational-thromboelastometry-rotem-in-dabigatran-anticoagulated-blood/. Accessed October 1, 2023.
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